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Flashcards in Neuropsychopharm 1 Deck (40):
1

What is the biochemical basis of depression?

Imbalance in biogenic amine neurotransmitter systems

2

Neurochemical effects of tricyclic antidepressants

Blockade of transmitter uptake -- NE and 5-HT

3

What are the most commonly used anti-depressants? What are the two we need to know?

SSRIs --Fluoxetine and Sertraline

4

Common SE of SSRIs?

N/V, Insomnia, Nervousness, Sexual dysfunction

5

What is serotonin reaction and why can it occur?

In the presence of MAOI's Include hyperthermia, muscle rigidity and CV collapse

6

What is SSRI Discontinuation syndrome?

Occurs within 1 to 7 days after stopping an SSRI; Most common with shorter acting drugs like sertraline; Symptoms include: dizziness, light-headedness, vertigo, anxiety, fatigue, h/a, tremor, visual disturbances

7

Clinical uses of SSRI's:

MDD, OCD, Panic disorder, social phobia, PTSD, GAD, PMS

8

First SSRI on the market, Active metabolite with long half-life, Effects on drug metabolism

Fluoxetine

9

SSRI, Similar to fluoxetine with less effects on drug metabolism, shorter half-life

Sertraline

10

Blocks both serotonin and Norepinephrine uptake

SNRI

11

SNRI, 12-18 hour half-life, Use with caution in patients with liver disease Approved for use with fibromyalgia, diabetic neuropathy, back pain, and osteoarthritis pain

Duloxetine

12

Drugs without typical tricyclic structure or SSRI action; may or may not block catecholamine uptake

Atypical antidepressants

13

Atypical antidepressant; approved for nicotine withdrawal and seasonal disorder; blocks NE and dopamine uptake

Bupropion

14

Atypical antidepressant; blocks presynaptic alpha2 receptors in the brain; increases appetite

Mirtazapine

15

First highly effective drugs for the treatment of depression; now used secondarily to SSRI's and other newer cmpds

Tricyclic antidepressants

16

Pharmacological properties of tricyclic antidepressants

1. produces elevation of mood in depressed patients after 2-3 weeks 2. Decreases REM and increase stage 4 sleep 3. Prominent anticholinergic effects 4. Sedation 5. Cardiac abnormalities

17

Symptoms of overdose with TCA

hyperpyrexia, hyper/hypotension, seizures, coma, cardiac conduction defects

18

Drug interactions with TCA's

Guanethidine -- blocks guanethidine uptake Sypathomimetic drugs -- particularly indirect acting ones Effects on absorption and metabolism of other drugs

19

Therapeutic uses of TCA's

MDD, Enuresis in childhood; chronic pain (amitriptyline); OCD (Clomipramine)

20

Two TCA's we need to know and what they're used for

Amitriptyline --> chronic pain Clomipramine --> OCD

21

Block the oxidative deamination of naturally occurring biogenic amines like NE, DA and 5-HT and ingested amines

MAOI's

22

Irreversible inhibitor of MAO

Phenelzine

23

What do you have to watch in your diet if you're on MAOI's?

Tyramine intake

24

Major mental disorder characterized by derangement of personality and loss of contact with reality, delusions, hallucinations

Psychosis

25

Which dopamine receptor activates adenylyl cyclase?

D1 type

26

Which dopamine receptor inhibits adenylyl cyclase?

D2 type

27

Which two receptors do atypical antipsychotic drugs act on?

DA + 5HT2 receptors

28

Actions of typical antipsychotic drugs

Decrease psychotic behavior, sedation, extrapyramidal actions, neuroendocrine effects, orthostatic hypotension; weight gain; neuroleptic malignant syndrome

29

Prototype available typical antipsychotic drugs (Class)

Phenothiazines-- 3 subtypes based on side chain: Chlorpromazine, Thioridazine, Fluphenazine

30

Compounds with aliphatic side chains; low to medium potency, sedative, pronounced anticholinergic actions

Chlorpromazine

31

Compounds with piperidine side chains; low potency, sedative, less extrapyramidal actions, anticholinergic

Thioridazine

32

Compounds with piperazine side chains; high potency, less sedative, less anticholinergic, more extrapyramidal reactions

Fluphenazine

33

Butyrophenone Derivative, not chemically related to phenothiazines but pharmacologically similar to high potency piperzine derivatives

Haloperidol

34

Atypical Antipsychotics

Clozapine, Olanzapine, Risperidone, Quetiapine, Aripiprazole

35

Less extrapyramidal symptoms, May cause serious agranulocytosis, weight gain; Effects on negative symptoms

Clozapine

36

More potent 5-HT2 antagonist; few extra pyramidal symptoms; no agranulocytosis; weight gain and diabetes risk

Olanzepine

37

Combined dopamine and serotonin receptor antagonist; low incidence of extrapyramidal side effects

Risperidone

38

Structurally related to clozapine with effects on D2 and 5-HT2 receptors; some abuse potential

Quetiapine

39

D2 partial agonist -- approved as an adjunct in the treatment of depression

Aripiprazole

40

Uses of atypical antipsychotics

Acute psychotic episodes, chronic schizo, manic episodes, augmentation of antidepressant action, Tourette's, Antiemesis